| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
1,635 |
1,445 |
$22K |
| V2100 |
Lens spher single plano 4.00 |
811 |
783 |
$19K |
| 92004 |
|
349 |
347 |
$16K |
| 92014 |
|
335 |
335 |
$14K |
| V2200 |
Lens spher bifoc plano 4.00d |
212 |
212 |
$8K |
| V2784 |
Lens polycarb or equal |
662 |
549 |
$6K |
| 92015 |
|
800 |
798 |
$5K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
251 |
243 |
$4K |
| 92340 |
|
138 |
138 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
34 |
34 |
$660.00 |
| 1036F |
|
296 |
296 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
297 |
297 |
$0.00 |
| G9902 |
Pt scrn tbco and id as user |
52 |
52 |
$0.00 |
| G8428 |
Cur meds not document |
12 |
12 |
$0.00 |
| G8785 |
Bp scrn no perf at interval |
387 |
387 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
414 |
414 |
$0.00 |
| 4040F |
|
326 |
326 |
$0.00 |
| G8482 |
Flu immunize order/admin |
91 |
91 |
$0.00 |